Risks & Complications of Rhinoplasty Operation

Possible Risks and Complications of Nose Job

Aesthetic nose surgery (rhinoplasty), perhaps the most difficult of all facial surgery operations. The vast majority of rhinoplasty surgeries are successful when performed by an experienced rhinoplasty surgeon, and no post-operative problems occur. However, the characteristics of the patient's healing tissue, the surgical technique used, and postoperative care affect the occurrence of these risks and complications. Nasal aesthetics is not a simple computer animation, and as with every surgical procedure, there are some risks associated with nasal aesthetic surgery. Rhinoplasty, commonly known as a nose job, is a popular cosmetic surgery procedure aimed at enhancing the appearance and functionality of the nose. While it is often performed successfully with transformative results, it is crucial for individuals considering rhinoplasty to be aware of the potential risks and complications associated with the surgery.

Rhinoplasty requires understanding of art and science. The attempt to form a specific shape and to create this shape has led to a variable, difficult and detailed surgical procedure rather than a standard procedure.

Complications can be defined as an unexpected medical or surgical condition. Each surgical procedure has its own risk of complications. Nasal aesthetic complications can be grouped in 4 ways according to the time of occurrence:

- Intraoperative complications (complications during surgery)
- Complications after surgery
- Complications of early edema after surgery
- Late postoperative complications

Complications of nose aesthetics can be classified as follows:

- Functional complications
- Infection related complications
- Aesthetic complications
- Psychological complications
- Personalized complications

According to the current literature, the complication rate for nose surgery varies between 4-19%. This ratio decreases as surgical experience increases. Skin and related soft tissue complications occur in 10% of cases. According to estimates, severe systemic or life-threatening complications occur in 1.7-5% of cases. Intracranial complications are rare.

The risk of complications can be reduced as minimally invasive techniques occur and materials with increased tissue compliance are produced.

The following are the risks and complications that may arise after surgery for nasal aesthetics:

• Nasal Obstruction: Perhaps it is among the most common side effects of rhinoplasty. After a successful nasal aesthetic, a good-looking and functioning nose should emerge. With modern rhinoplasty techniques and accurate analysis and diagnosis of the patient's nose before surgery, problems of breathing can be avoided.

After two rhinoplasty operations were performed in a different clinic, the above patient presented to our clinic due to many deformities and problems such as collapse at the tip of the nose, fistulized holes, and collapse. The hole (fistula) in the patient's left nasal wing is visible.

• Discomfort with Cosmetic Appearance: Because the nasal aesthetic changes the intended nasal shape, it is possible to experience discomfort with the post-operative appearance, even if there is no true deformity or abnormality. It may reduce your chances of communicating clearly with your surgeon before surgery to communicate your goals and expectations. Computer transitions (simulations) or traces covering your pre-operative photographs can help you and your surgeon agree with the recommended results. It is emphasized that the newly published by American Academy of Otolaryngology-Head and Neck Surgery Rhinoplasty Guideline >> Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty

• Bleeding: There is a risk of bleeding for the first 10 days, with a higher probability of first 3 days after rhinoplasty. Patients with bleeding disorders with NSAIDs (non-steroidal anti-inflammatory drugs such as ibuprofen, naproxen, aspirin), blood thinners, or personal family history are at higher risk.

• Infection: Any surgery infects the risk of infection. Sensitivity to the sterile operating room environment may reduce this risk (the emphasis of the hospital is on emphasis).


Nasal pyogenic granuloma

In the above photo, a granulation tissue is seen in the nose (welded from the top to the inside of the nostril) in a patient who underwent a nasal surgery three weeks ago. Treatment with simple antibiotic pomade and silver nitrate application is complete.

The beginning of nasal septum perforation after 4th revision rhinoplasty!

In the photo above, the patient who had a revision rhinoplasty operation in another clinic and the internal silicone splints were removed 1 week after the operation, came to us because of the infection and destruction of the mucosa in the anterior part of the nasal septum, the inflamed area, and the cartilage placed below. As seen in the above photograph of the patient, the causes of mucosal damage and infection in the area where the silicone splints were sutured to the nasal septum can be highlighted as follows:

- very tight suturing of silicone splints and reducing mucosal blood supply, causing necrosis

- sewing reaction

- the emergence of circulatory disorders due to repeated operations of the patient

- traumatizing the patient with a cotton swab, napkin or finger and causing the infection

In revision nose operations, it is necessary to make the least possible surgical trauma and to protect the patient from risks.

In patients with such infection, nasal septum perforation, infection and deformation of nasal cartilage grafts may occur.

• Scarring: After open surgical nasal aesthetic surgery, a noticeable incision trace may occasionally appear at the incision site at the nasal tip. Usually this heals well and is not noticed at the scarring distance (there are also the disadvantages of open technique nose aesthetics as well as the advantages).

• Nasal Deformity: During the healing process in the bone or cartilaginous areas after cartilaginous or nasal cartilaginous processes, cartilage and bone tissue changes that may cause asymmetric appearance may occur.



Crooked nose - Deviated nose - Twisted nose - Asymmetric Nose



Pollybeak Deformity

In the photo left side, photographs of the nose of a patient who had undergone a nose surgery in a different clinic and whose nose was Pollybeak Deformity and Curved Nose Deformity appeared. In the patient who had nasal rasping with closed technique, it appears that a bird-like gag-like appearance appeared when the side of the bone section of the nasal arch was retreated and accompanied by inadequate resection of cartilage tissue underneath the nose arch.

• Nose tip drooping (or nose tip sagging): The nose support is being reconstructed during nasal surgery. In order to increase the nasal support, cartilage grafts are usually placed on the tip of the nose and the existing natural nasal support cartilages are protected. If the nose support is impaired during nasal endovascular surgery and if there is not enough repair, nasal tip drops may occur after the operation.







Dropped Tip After a Nose Tip Plasty

In the above photo, nose tip droop emerging in the patient who had previously undergone nose tip plasty operation is seen. In order to prevent this situation, which can be seen after nose tip lifting and nose tip plasty operations performed especially by using only single sewing techniques, nose tip zone support should be reconstructed with additional cartilage grafts (such as columellar strut grafts). 

• Septal Perforation (or Nasal Septum Perforation): It is possible to create a permanent hole in the septum of the nose after surgery if the membrane covering both sides of the septum and the middle cartilage are damaged in full thickness.



Nasal Septum Perforation

In the above photograph, a perforation area in the septum of the nose is seen in a patient who had previously undergone a septorinoplasty operation in another clinic.

Risks & Complications of
Rhinoplasty Operation

It can usually be recognized by the patient when septal perforation is small. When they are small, whistling may be heard when breathing through as the air enters through the small hole. If it is large, the hole may serve as an area for collecting and forming a mucus shell. Septal holes have a tendency to contribute to nasal obstruction. Apart from this, causing anomalous accelerated airflow (hyperventilation) in the nose, decrease in nasal functions can lead to nasal desiccation and nasal bleeding. You can find detailed indormation about nasal septum perforation at >> Nasal Septal Perforation - Definition, Causes, Symptoms, Diagnosis and Treatment

• Surgical Suture (Stiche Material) Reactions: During nasal surgery, tissue reactions can occur due to permanent suture materials (for this reason I usually prefer to use absorbable suture materials).

Foreign Body Reactions Due to Non-Absorbable Suture Materials and Skin Fistula After Rhinoplasty Operation

In the above video, a patient who had undergone nose job surgery surgery 4 times previously and was injected with local anesthetic drug at the tip of the nose before the operation of the patient with complaints of recurrent skin infections, outflow, skin collapse and nasal breakdown, seems to have gone out. You can find more information on the link >> Foreign Body Reactions Due to Non-Absorbable Suture Materials and Skin Fistula After Rhinoplasty Operation

Rhinoplasty is described as "the most difficult of all facial plastic surgery procedures". As with all surgical procedures, there are risks and benefits. When deciding whether or not to have surgery, the weight of the risks and complications should be assessed with the benefits of rhinoplasty with the patient's surgeon.

As with all surgical procedures, the main risks include infection, bleeding and anesthesia-related reactions. Fortunately, all of them are extremely smooth. The most common complication following rhinoplasty is a functional problem in respiration or a cosmetic problem, both of which require revision surgery in some cases. The most authoritative rhinoplasty surgeons have revision surgery rates between about 3% and 7%.

Although rhinoplasty surgery is generally considered a safe surgical procedure, complications can sometimes occur. The great majority of complications stem from dissatisfaction with aesthetic outcomes. Revisional surgery may sometimes be necessary under these conditions. Nasal aesthetic surgeries are usually performed under general anesthesia, and anesthesia also has its own risks.

The photos the side and below shows the dark scar tissue in the columellar incision area due to the suture reaction of the patient, who had previously undergone rhinoplasty in another clinic three times. The patient reports that inflammatory discharge comes from this area every few days.

Rhinoplasty can be a transformative and rewarding experience for individuals seeking to enhance both the aesthetic and functional aspects of their noses. However, like any surgical procedure, it comes with inherent risks and complications. Understanding these risks, being informed about the procedure, and choosing a qualified surgeon are critical steps towards achieving a successful and satisfying rhinoplasty outcome. By prioritizing safety and well-informed decision-making, individuals can navigate the journey of rhinoplasty with confidence and achieve the desired results while minimizing potential complications.

The patient presented to our clinic with prolonged inflammatory discharge from the nasal tip and the formation of raised granulation tissue on the skin after rhinoplasty at another clinic. The patient's left nostril was almost completely closed due to stenosis. We planned for open technique revision rhinoplasty, fistula repair, removal of foreign bodies (suture materials), and nostril stenosis repair.

The patient presented to our clinic with persistent inflammatory discharge and sunken areas on the tip of the nose, which started several months after rhinoplasty at another clinic. We planned for open revision rhinoplasty, foreign body reaction excision, and fistula excision.

The above image, obtained during surgery, shows nasal hairs inverted under the skin forming an abscess, along with several foreign objects (the image may be bloody and disturbing).

Septo-Columeller Suture Protrusion From Mucosa

The septo-columeller suture, used to stabilize the nasal tip and caudal septum during rhinoplasty, nasal tip reshaping, or septoplasty operations, can sometimes protrude from the mucosa in the columellar pocket or nasal vestibule, usually due to the use of non-absorbable materials or localized inflammation. In a patient who underwent rhinoplasty two years ago, a prolene-compatible permanent suture material was found to have protruded from inside the nose, just behind the columella and above the nasal vestibule. The suture was removed simply by cutting it. I generally avoid using permanent suture material during surgery whenever possible. While septo-columeller sutures are commonly used in open rhinoplasty procedures, septo-columeller sutures are also safely applied in closed rhinoplasty to manage nasal tip protrusion and rotation. The reason surgeons use this suturing technique is that its benefits include increasing nasal tip stability (strengthening the nasal tip and providing long-term stability in the desired position), allowing for nasal tip rotation according to the patient's wishes (turning the nose up or down), and simultaneously reducing the need for extensive dissection and limiting structural deformation of the nasal tip. However, permanent suture materials are more often preferred, and it carries the risk of the suture protruding from the skin or mucosa, as shown in the photograph. In the long term, there is no change in the shape of the nasal tip after the suture is removed. On this website, you can find links to patients who have undergone surgery in various clinics and whose cases involved sutures protruding from the nasal skin, causing inflammatory discharge, and complications related to nasal implants.

L Shaped Nasal Silicone Implant Problems, Removal and Revision Rhinoplasty

In the Far East, L-shaped silicone nasal implants are frequently used for augmentation of flattened noses (augmentation rhinoplasty). The image above shows a patient who, after rhinoplasty using silicone implants in China, presented with complaints of a dislodged implant and asymmetry on the nose, as well as a shift in the shape of the nose to the right or left when smiling and speaking. A revision rhinoplasty using rib cartilage and removal of the L-shaped silicone nasal implant was planned (Image may be bloody and disturbing).

During a revision rhinoplasty operation performed using an open technique, the L-shaped silicone nasal implant was removed. A similar graft was prepared using rib cartilage to replace the implant, resulting in a nose shape as shown above.

L-Shaped Silicone Nasal Implant Moves on the Nose Video

The video above shows a different patient. In this patient, during rhinoplasty with L-shaped silicone implants performed in another country, the implant, which had shifted to the right and left on the nasal bridge causing an asymmetrical appearance, was removed during the operation.

Nasal Skin Necrosis After Rhinoplasty: A Rare But Serious Complication

The patient, who underwent rhinoplasty at a different clinic, has a skin injury on the left side of the nasal bridge, as seen in the photos, immediately after the operation. Subsequently, an infection and necrotic skin area appeared in this region. The doctor followed up with an antibiotic bandage (Bactigras antiseptic gauze dressing) and administered hyperbaric oxygen therapy. Eventually, a sunken, dark-colored scar area appeared on the nose. The photos of this case are shared in chronological order. The causes of this skin necrosis in the patient can be listed as follows:

- Thinning and accidental cutting of the skin in a way that disrupts skin circulation (generally, during rhinoplasty, the skin on the nasal bridge, including the bone periosteum, should be removed in the thickest possible layer). As seen in the images, the damaged area of ​​skin on the nasal bridge is visible immediately after the operation (red arrow). - Excessive trauma to the skin during nasal bridge reduction (this was especially noticeable with older metal bone files, but accidentally hitting the skin directly with the micromotor can also be a cause)

- Excessive cauterization

- Operating room infection and skin infection

- Excessive pressure bandaging and resulting skin circulation problems

- Uncontrolled systemic diseases such as diabetes that can increase the risk of skin infection or cause impaired circulation in the patient (this patient did not have such a health problem)

- Postoperative exposure to cigarette smoke and contaminated particulate environments

I have included separate images of the patient below:

Link group where you can read articles about Rhinoplasty Complications previously published on this website >> https://www.ent-istanbul.com/search?q=Rhinoplasty+Complications

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
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